Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated$18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the$40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment

Long Island Follows Bumpy New York Road to National Health Reform

At first glance, New York and the Long Island metropolitan area appear well positioned for smooth implementation of the federal Patient Protection and Affordable Care Act (ACA) of 2010, according to a new Center for Studying Health System Change (HSC) study of Long Island's commercial and Medicaid insurance markets (see Data Source). Key ACA reforms—expanded Medicaid eligibility, premium rating restrictions in the nongroup, or individual, and small-group markets, minimum medical loss ratios (MLRs)—have long been features of New York's broad public health insurance programs and highly regulated health insurance market. Once the ACA became law, there was little doubt that New York would embrace reform. Yet, partisan gridlock in Albany has made for a rough road to health reform for New York. After many months of wrangling with the state Legislature, Gov. Andrew Cuomo (D) resorted to authorizing the state health insurance exchange by executive order in 2012, giving New York's exchange a later start than in many states. Another threat to successful implementation is the state's commitment to stringent insurance regulations that exceed ACA requirements, most notably in small-group and nongroup community rating. Most respondents expected stricter state regulations to keep New York nongroup premiums very high and lead many healthier state residents to continue staying out of the nongroup risk pool. However, when 2014 premiums were released in July, the approved rates were lower than most had expected. What remains uncertain is how sustainable these rates will be over time—specifically, whether they will remain sufficiently low to attract and retain a sizable pool of younger, healthier enrollees

Changes in U.S. Hospitalization and Mortality Rates Following Smoking Bans

U.S. state and local governments are increasingly restricting smoking in public places. This paper analyzes nationally representative databases, including the Nationwide Inpatient Sample, to compare short-term changes in mortality and hospitalization rates in smoking-restricted regions with control regions. In contrast with smaller regional studies, we find that workplace bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases. An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a workplace ban are as common as the large decreases reported in the published literature.

Greater deciduous shrub abundance extends tundra peak season and increases modeled net CO₂ uptake

Satellite studies of the terrestrial Arctic report increased summer greening and longer overall growing and peak seasons since the 1980s, which increases productivity and the period of carbon uptake. These trends are attributed to increasing air temperatures and reduced snow cover duration in spring and fall. Concurrently, deciduous shrubs are becoming increasingly abundant in tundra landscapes, which may also impact canopy phenology and productivity. Our aim was to determine the influence of greater deciduous shrub abundance on tundra canopy phenology and subsequent impacts on net ecosystem carbon exchange (NEE) during the growing and peak seasons in the arctic foothills region of Alaska. We compared deciduous shrub-dominated and evergreen/graminoid-dominated community-level canopy phenology throughout the growing season using the normalized difference vegetation index (NDVI). We used a tundra plant-community-specific leaf area index (LAI) model to estimate LAI throughout the green season and a tundra-specific NEE model to estimate the impact of greater deciduous shrub abundance and associated shifts in both leaf area and canopy phenology on tundra carbon flux. We found that deciduous shrub canopies reached the onset of peak greenness 13 days earlier and the onset of senescence 3 days earlier compared to evergreen/graminoid canopies, resulting in a 10-day extension of the peak season. The combined effect of the longer peak season and greater leaf area of deciduous shrub canopies almost tripled the modeled net carbon uptake of deciduous shrub communities compared to evergreen/graminoid communities, while the longer peak season alone resulted in 84% greater carbon uptake in deciduous shrub communities. These results suggest that greater deciduous shrub abundance increases carbon uptake not only due to greater leaf area, but also due to an extension of the period of peak greenness, which extends the period of maximum carbon uptake

Far-infrared observations of a massive cluster forming in the Monoceros R2 filament hub

We present far-infrared observations of Monoceros R2 (a giant molecular cloud at approximately 830 pc distance, containing several sites of active star formation), as observed at 70 μm, 160 μm, 250 μm, 350 μm, and 500 μm by the Photodetector Array Camera and Spectrometer (PACS) and Spectral and Photometric Imaging Receiver (SPIRE) instruments on the Herschel Space Observatory as part of the Herschel imaging survey of OB young stellar objects (HOBYS) Key programme. The Herschel data are complemented by SCUBA-2 data in the submillimetre range, and WISE and Spitzer data in the mid-infrared. In addition, C18O data from the IRAM 30-m Telescope are presented, and used for kinematic information. Sources were extracted from the maps with getsources, and from the fluxes measured, spectral energy distributions were constructed, allowing measurements of source mass and dust temperature. Of 177 Herschel sources robustly detected in the region (a detection with high signal-to-noise and low axis ratio at multiple wavelengths), including protostars and starless cores, 29 are found in a filamentary hub at the centre of the region (a little over 1% of the observed area). These objects are on average smaller, more massive, and more luminous than those in the surrounding regions (which together suggest that they are at a later stage of evolution), a result that cannot be explained entirely by selection effects. These results suggest a picture in which the hub may have begun star formation at a point significantly earlier than the outer regions, possibly forming as a result of feedback from earlier star formation. Furthermore, the hub may be sustaining its star formation by accreting material from the surrounding filaments

Changes of dust opacity with density in the Orion A molecular cloud

We have studied the opacity of dust grains at submillimeter wavelengths by estimating the optical depth from imaging at 160, 250, 350, and 500 μm from the Herschel Gould Belt Survey and comparing this to a column density obtained from the Two Micron All Sky Survey derived color excess E(J – Ks). Our main goal was to investigate the spatial variations of the opacity due to "big" grains over a variety of environmental conditions and thereby quantify how emission properties of the dust change with column (and volume) density. The central and southern areas of the Orion A molecular cloud examined here, with NH ranging from 1.5 × 1021 cm–2 to 50 × 1021 cm–2, are well suited to this approach. We fit the multi-frequency Herschel spectral energy distributions (SEDs) of each pixel with a modified blackbody to obtain the temperature, T, and optical depth, τ1200, at a fiducial frequency of 1200 GHz (250 μm). Using a calibration of NH/E(J – Ks ) for the interstellar medium (ISM) we obtained the opacity (dust emission cross-section per H nucleon), σe(1200), for every pixel. From a value ~1 × 10–25 cm2 H–1 at the lowest column densities that is typical of the high-latitude diffuse ISM, σe(1200) increases as N 0.28H over the range studied. This is suggestive of grain evolution. Integrating the SEDs over frequency, we also calculated the specific power P (emission power per H) for the big grains. In low column density regions where dust clouds are optically thin to the interstellar radiation field (ISRF), P is typically 3.7 × 10–31 W H–1, again close to that in the high-latitude diffuse ISM. However, we find evidence for a decrease of P in high column density regions, which would be a natural outcome of attenuation of the ISRF that heats the grains, and for localized increases for dust illuminated by nearby stars or embedded protostars

Absorbance based light emitting diode optical sensors and sensing devices

The ever increasing demand for in situ monitoring of health, environment and security has created a need for reliable, miniaturised sensing devices. To achieve this, appropriate analytical devices are required that possess operating characteristics of reliability, low power consumption, low cost, autonomous operation capability and compatibility with wireless communications systems. The use of light emitting diodes (LEDs) as light sources is one strategy, which has been successfully applied in chemical sensing. This paper summarises the development and advancement of LED based chemical sensors and sensing devices in terms of their configuration and application, with the focus on transmittance and reflectance absorptiometric measurements

Antibiotic resistance in the environment, with particular reference to MRSA

The introduction of β-lactam antibiotics (penicillins and cephalosporins) in the 1940s and 1950s probably represents the most dramatic event in the battle against infection in human medicine. Even before widespread global use of penicillin, resistance was already recorded. E. coli producing a penicillinase was reported in Nature in 1940 (Abraham, 1940) and soon after a similar penicillinase was discovered in Staphylococcus aureus (Kirby, 1944). The appearance of these genes, so quickly after the discovery and before the widespread introduction of penicillin, clearly shows that the resistance genes pre-dated clinical use of the antibiotic itself